450-P: Pulse Pressure as a Predictor of Cardiovascular Events in Cardiovascular Disease Patients with Differing Glycemic State

Pulse pressure, i.e. the difference between systolic and diastolic blood pressure is a measure of arterial stiffness, which is a strong predictor of cardiovascular risk. The power of pulse pressure to predict cardiovascular events in patients with differing glycemic state is unclear and is addressed in the present study. We prospectively recorded cardiovascular events in a high-risk cohort of 1787 patients with cardiovascular disease (1472 patients with angiographically proven coronary artery disease and 315 with sonographically proven peripheral artery disease), over a mean follow-up period of 10.7±5.0 years. At baseline, pulse pressure significantly increased from patients with NFG (n=690) over those with IFG (n=505) to those with T2DM (n=592; 56±17 mmHg, 58±15 mmHg and 59±18 mmHg, respectively; p_trend=0.002). During follow-up, 913 of our patients suffered cardiovascular events; the incidence of cardiovascular events increased significantly from subjects with NFG over those with IFG to those with T2DM (49.9%, 44.2% and 60.3%, respectively; p_trend<0.001).Pulse pressure in the total study population predicted cardiovascular events (standardized adjusted HR 1.13 [1.05-1.22], p<0.001) in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol and also after additional adjustment for the baseline glycemic state (HR=1.12 [1.04-1.21], p=0.002). In subgroup analyses, standardized adjusted HRs were 1.15 [1.02-1.30], p=0.027), 1.00 [0.85-1.17], p=0.971) and 1.17 [1.05-1.31], p=0.006) in patients with NFG, IFG and T2DM, respectively. An interaction term puls pressure by glycemic state was not significant (p=0.310), indicating that the glycemic state did not significantly impact the power of pulse pressure to predict cardiovascular events. From our data we conclude that pulse pressure is a predictor of cardiovascular events in CVD patients irrespective of the baseline glycemic state.